Cloud Documentation
Advanced Search


Using Benefits
Close Window

 

This guide also applies to on-premise implementations

Table of Contents

Show All | Collapse

4 Manage Open Enrollment Period

This chapter contains the following:

Benefits Open Enrollment: Overview

Preparing Program and Plan Configuration for Open Enrollment: Critical Choices

Adding the Open Scheduled Event: Critical Choices

Reinstatement Rules: Critical Choices

Managing Rates for Open Enrollment: Points to Consider

Restarting Coverage for Flexible Spending Accounts: Points to Consider

Configuring Enrollment Display: Points to Consider

Identifying and Resolving In-Progress Life Events Before Open Enrollment: Explained

Processing Trial Open Enrollment: Explained

Managing Open Enrollment Period: Explained

Scheduled Event Participation Process: Points to Consider

Monitor Processes and Resolve Errors: Explained

Processing Life Events That Occur During Open Enrollment Period: Examples

Enter Enrollments: Explained

Setting Up and Processing an Open Enrollment Period: Worked Example

Manage the Open Enrollment Window: Explained

Tasks after Open Enrollment Period Ends: Explained

Benefits Open Enrollment: Overview

The benefits open enrollment process comprises three phases: preparation, the enrollment period, and post enrollment activities. This chapter provides a sample timeline, checklists, and instructions to guide you through the phases of open enrollment.

Open Enrollment Period Opportunities

The open enrollment period is an opportunity for eligible participants to:

  • Enroll in a plan if not currently enrolled

  • Change coverage from one plan to another

  • Change enrollment status of eligible family members

  • Decline coverages

Open enrollment is also an opportunity for your organization to:

  • Modify plan configuration

  • Update rates

  • End benefits offerings

  • Start new benefits offerings

Sample Open Enrollment Timeline

This sample timeline and the instructions in this chapter assume the following dates and rules:

  • Open enrollment elections are effective on January 1.

  • Coverage begins on January 1.

  • Rates begin on January 1.

  • Coverages and rates start on the event date.

  • Previous year coverages and rates end one day before the event date.

You must thoroughly test the open enrollment procedures using your configuration if either of the following conditions is true:

  • Your organization's open enrollment is effective on any other date within the year.

  • You apply different coverage and rate start and end date rules to meet your business requirements.

The following timeline outlines suggested activities before, during, and after an open enrollment period that lasts throughout the month of November.


Month

Details

September and October

Update plan configuration

Run a trial open enrollment:

  • Test performance

  • Test self-service enrollment

01-November

Run the open event processing:

  • Evaluate Scheduled Event Participation

  • Enroll in Default Benefits

Throughout November

Elect benefits:

  • Participants enter elections using the self-service guided process.

  • Benefits administrators enter elections in the Enrollment work area.

02-15 December

  • Benefits administrators may still enter elections as necessary by setting a session effective date within the enrollment period of November.

15-December

Run the Close Enrollment process to close all elections.

Phase One Checklist: Before the Open Enrollment Period Starts

Follow these steps to prepare for the open enrollment period:


Task

Work Area

Check payroll calendars.

Contact payroll administrator

Check plan year periods.

Plan Configuration

Assess and update eligibility profiles and derived factors.

Plan Configuration

Prepare program and plan configurations:

  • End existing plans no longer offered.

  • Add new plans.

  • Add new options to existing plans.

Plan Configuration

Add the open scheduled life event to the program or plan not in program.

Plan Configuration

Manage standard and variable rates:

  • Add rates to new benefits objects.

  • Modify rates on existing benefits objects.

  • Modify elements on existing rates.

  • Modify flex credit offerings.

Plan Configuration

Start new coverage for flexible spending accounts (FSA)

Plan Configuration

Configure enrollment and rate display.

Plan Configuration

Identify and resolve in-progress life events:

  • Identify conflicting and incomplete life events

  • Identify and finalize open action items and suspensions

  • Evaluate and resolve temporal event participation

Evaluation and Reporting

Enrollment

Process trial open enrollment.

Evaluation and Reporting

  • Test trial open enrollment.

Enrollment

My Information (Self-Service)

  • Analyze and tune performance.

Evaluation and Reporting

Phase Two Checklist: During the Open Enrollment Period

Follow these steps to administer the open enrollment period:


Task

Work Area

Generate the Participant Enrollment Results report.

Reports and Analytics

Manage the open enrollment period.

  • Run the Evaluate Scheduled Event Participation and Enroll in Default Benefits processes.

Evaluation and Reporting

  • Monitor processes and resolve errors.

Evaluation and Reporting

  • Enter enrollments.

My Information (Self-Service)

Enrollment

  • Process life events that occur during the open enrollment period.

Enrollment

Manage and close the open enrollment window.

Evaluation and Reporting

Generate the Participant Enrollment Results report.

Reports and Analytics

Phase Three Checklist: After the Open Enrollment Period Ends

Follow these steps to complete the open enrollment activities:


Task

Work Area

Verify enrollment.

Enrollment

Investigate incorrect enrollments.

Enrollment

Close action items and certifications.

Enrollment

Enter overrides.

Enrollment

Inactivate plans that are no longer offered.

Plan Configuration

Process life events that occur after open enrollment.

Enrollment

Preparing Program and Plan Configuration for Open Enrollment: Critical Choices

When you prepare program and plan configurations for open enrollment:

  • Verify periods for payroll calendars and year periods for programs and plans

  • Check derived factors and eligibility profiles

  • Inactivate existing plans and options that are ending

  • Create options and plans and add to existing plans and programs

  • Check default enrollment rules

  • Check unrestricted processing enablement

Verify Periods for Payroll Calendars and Year Periods for Programs and Plans

Check with the payroll administrator:

  • That the payroll periods for your benefits plans extend through the entire new plan year

  • Whether the upcoming plan year has standard 52 or 26 pay periods or nonstandard 53 or 27 pay periods, respectively, if using biweekly or weekly period types.

In the Setup and Maintenance work area:

  • Verify that a year period is defined for the new plan year or create year periods, as required using the Manage Year Periods task.

In the Plan Configuration work area:

  • Verify that all active programs and plans include the correct year periods using the Basic Details pages in the Plan Configuration work area.

  • If your business calculates communicated rates using pay periods, also check that the correct communicated rate frequency is selected, especially if the upcoming plan year has nonstandard weekly or biweekly pay periods.


    Communicated Rate Frequency

    Description

    Per pay period

    Uses the number of pay end dates derived from the payroll definition. For example, a weekly payroll might result in 53 end dates in the calendar year.

    Estimated per pay period

    Uses the standard number of periods corresponding to the period type value selected in the payroll definition, regardless of the number of pay end dates in the calendar year. For example, communicated rate calculations use the fixed number of 52 weekly periods, even for years with the nonstandard 53 weekly periods.

    Per pay period with element frequency rules

    Uses the frequency rules of the payroll element associated with the standard rate to determine the number of deductions in the calendar year. For example, one of your benefit deductions occurs only on the first biweekly payroll in each month.

    If you use this communicated rate frequency, select Per-pay-period amount as the value passed to payroll.

Check Derived Factors and Eligibility Profiles

Check and edit existing eligibility configuration and add missing eligibility configuration as required. Use the tasks under Manage Eligibility in the Tasks pane of the Plan Configuration work area.

For example:

  • You created benefit offerings for spousal and child life that require new age derived factors.

  • You have new requirements that require you to edit length of service derived factors.

  • You evaluate associated eligibility profiles for benefits objects requiring many manual participation eligibility overrides to determine how to better include and exclude participants, thus reducing or ending the manual overrides.

  • Your service areas are changing, so you must modify the existing postal codes and service areas accordingly.

Inactivate Existing Plans and Options That Are Ending

Inactivate plans or options that are no longer offered in the new plan year to stop existing participant enrollments and prevent new enrollments.

In the Plan Configuration work area:

  1. Using the effective start date of the upcoming plan year as your effective as-of date, search for the programs or plans that contain the plans or options that are ending.

    Note

    The effective as-of date becomes the session effective date at the top of the edit plan pages. The session effective date becomes the new effective start date for plans and options that you update, after you save your changes.

  2. On the edit Basic Details page for the program or plan, select the plan or option that you want to end.

  3. Update the plan or option, setting the status to Inactive and saving your change.

    Check that the effective start date for when the plan or option becomes inactive changed to the session effective date at the top of the page, for example, January 1, 2016.

  4. On the Enrollment page, select the plan or option that you want to end.

  5. Update the Enrollment section on the General tab, setting the enrollment rule to Current - lose only; new - nothing and saving your change.

    Check that the updated plan or option Enrollment field contains a checkmark and the effective start date changed to the session effective date for the page, such as January 1, 2016. Now when you process the open event, all existing plan or option participants are disenrolled on the new effective start date and no new participants can enroll in it.

Create Options and Plans and Add To Existing Plans and Programs

Create the option or plan for the upcoming plan year in the Plan Configuration work area.

For new options and plans:

  • Set the session effective date at the top of the create page to the first day of a plan year at least a few years earlier, for example, January 1, 1951.

    Note

    The effective as-of date becomes the session effective date at the top of the edit plan pages. The session effective date becomes the effective start date for plans and options that you create, after you save your changes.

  • Set the option or plan status to Pending.

For new plans:

  • Add year periods that include the current plan year and the upcoming plan year. For example, if the upcoming plan year starts January 1, 2016, then, at minimum, add year periods from January 1, 2015 to December 31, 2015 and January 1, 2016 to December 31, 2016.

For each plan to which you want to add the new option, or program to which you want to add the new plan:

  1. Set the session effective date at the top of the Basic Details page to the first day of the current plan year, for example, January 1, 2015.

  2. Add the new option or plan, setting the status to Pending and click Save. The effective start date should be the first day of the current plan year.

  3. Set the session effective date at the top of the edit program page to the first day of the upcoming plan year, for example, January 1, 2016.

  4. Update the option or plan status to Active for the newly added option or plan and click Save.

    The newly added option or plan status should have changed from Pending to Active and the effective start date should now be the first day of the upcoming plan year.

For plans not in program:

  1. Set the session effective date using the current plan year, set the status, and add year periods, just as you do when creating plans.

  2. Follow the preceding steps 3 and 4 to set a new session effective date using the upcoming plan year and update the plan status to Active.

Check Default Enrollment Setup

For all active programs, plans, and options, check that the selected enrollment methods and default enrollment rules are still valid for your latest program and plan designs. Check these methods and rules on the General and Life Event tabs of the edit program or plan Enrollment pages.

Where the default enrollment rule is New - default; current - same enrollment and rates, participants who are:

  • New to an electable benefits object are assigned the default plan or option.

  • Currently enrolled and make no explicit election changes retain their same enrollment. Rates are recomputed based on the plan configuration. If the coverage or rate was entered at the time of enrollment, then the current benefit and rate amount for the participant are retained by default.

Tip

Use the Automatic enrollment method when you do not want workers to change the default elections that you set.

Check Unrestricted Processing Enablement

To allow enrollment in unrestricted plans during open enrollment, you must disable the regular unrestricted processing. Otherwise, the regular unrestricted processing backs out the unrestricted open enrollments. Use the Manage Self-Service Configuration task in the Plan Configuration work area to set unrestricted processing enablement to Not during open enrollment.

Note

Unrestricted programs and plans run on entirely different business relationships than the regular, life event driven programs and plans. This means that you can process an unrestricted life event on the same day that you process a regular life event.

Adding the Open Scheduled Event: Critical Choices

When you add an open scheduled event to a program or to plans not in program, you must specify the dates and enrollment rules for processing.

This topic discusses:

  • Adding the open scheduled event

  • Creating the enrollment period

  • Selecting the assigned life event date

  • Selecting the close enrollment period date rule

  • Selecting the reinstatement rule

Adding the Open Scheduled Event

To add the open event:

  1. In the Plan Configuration work area, click the Enrollment step for the program or plan not in program.

  2. Select the program or plan not in program in the hierarchy, then select the Scheduled tab.

  3. Select Open from the list, which by default is set to create an Administrative event.

  4. Click Create in the Periods section.

  5. Create the enrollment period.

Creating the Enrollment Period

This table lists the configurable fields with a description and sample recommended value. The sample dates are based on the scenario of an open enrollment period throughout the month of November, with the elections taking effect on January 1 of the following year.


Field

Description

Sample Recommended Values

Enrollment Period Start Date

First day of the open enrollment period.

November 1, 2015

Enrollment Period End Date

Last day of the open enrollment period.

November 30, 2015

Assign Defaults Date

Date on which default benefits assignments are made. Typically, this is the same date as the open enrollment period start date so that participants can minimally see their waive or prior elections when enrolling.

November 1, 2015

Assigned Life Event Date

Effective date of the Open event. The date as of which eligibility is evaluated and rates are determined. For the open event, this date is typically the first day of the new benefit year.

January 1, 2016

Processing Cutoff Date

The last day on which the benefits professional can make election changes on behalf of the participant.

December 15, 2015

Close Enrollment Period Date Rule

Occurrence that causes the Open event to advance from the started to processed phase.

When processing ends

Year Period

Year in which benefit elections are effective.

January 1, 2016 to December 31, 2016

Period Determination Rule

How enrollment periods are determined when an event is backed out and reprocessed, or when the event occurs within the enrollment window of another life event.

Later of enrollment period start or future start

Coverage Start Date

Select the rule that meets your business requirements. For example, select Event if you want the coverage for the benefit plan to start on the assigned life event date, which is January 1, 2016 in this example.

Event

Previous Coverage End Date

Select the rule that meets your business requirements. For example, if you select Event as the coverage start date rule, then select the corresponding 1 day before event rule to end the previous coverage the day before the assigned life event date, which is December 31, 2015 if the event date is January 1, 2016.

1 day before event

Rate Start Date

Select the rule that meets your business requirements. For example, select Event if you want the rates for the benefit plan to start on the assigned life event date, which is January 1, 2016 in this example.

Event

Previous Rate End Date

Select the rule that meets your business requirements. For example, if you select Event as the rate start date rule, then select the corresponding 1 day before event rule to end the previous rate the day before the assigned life event date, which is December 31, 2015 if the event date is January 1, 2016.

1 day before event

Selecting the Assigned Life Event Date

The event date is important for the consideration of derived factors based on age, such as imputed income. For example, imputed income in the US is calculated using the participant's age as of the end of the current year. So for the plan year 2016, the participant's age is calculated as of December 31, 2016. If the assigned life event date is in late December of 2015 for the 2016 plan year, the person's age would be calculated as of December 31, 2015, which would be incorrect for imputed income purposes.

Selecting the Close Enrollment Period Date Rule

Specify the date that fits your business requirement for the open event, for example:

  • Select When processing ends when there is a time between the end of the participant's enrollment period and the date of the open event. This enables you to make adjustments before the event is closed.

  • Select When enrollment period ends if there are no additional processing days after the enrollment period ends.

Selecting the Reinstatement Rule

The Reinstate all if no electability change in event rule is the default reinstatement rule that applies for any life event that you create. During an open enrollment period, a reinstatement rule enables you to restore elections if:

  • The open event was accidentally backed out

  • An intervening life event backs out the open event

The default rule restores elections only if there are no changes to the open enrollment electable choices between the date that the open event was backed out and the date when you reprocessed it. You can reinstate elections only if the life event was backed out using the Unprocessed status.

Reinstatement Rules: Critical Choices

Use reinstatement rules to control how participant elections are restored when you back out and reprocess a life event. For example, you back out an open enrollment event for a participant to make changes to some benefit offerings. When you reprocess the open event, the elections that the participant made before you backed out the open event are restored depending on the reinstatement rule that you configured for the open event.

You can select one of the following reinstatement rules on the Life Event tab of the Enrollment step when you create or edit a program or plan in the Plan Configuration work area:

  • Reinstate all if no electability change in life event

  • Reinstate if no change for backed out enrollment

  • Reinstate if electability exists for backed out result

  • Never Reinstate

If you do not select a reinstatement rule, then the Reinstate all if no electability change for life event rule is used by default to restore elections.

Important

When you reprocess a backed out life event, participant elections are restored only if the life event was backed out using the Unprocessed status.

Reinstatement Rules

The following table describes each reinstatement rule and when to use it.


Rule

Description

When to Use

Reinstate All If No Electability Change In Life Event

Elections are restored if there is no change in the electable choice data between the backed out date and the date when you reprocessed the life event.

For example, if a rate value or definition changes, then the elections are not restored.

When changes in electable choices might influence the participant's election decisions and you want the participant to review and make new elections.

Reinstate If No Change for the Backed Out Enrollment

Elections are restored if the electable choices that the participants originally chose remain the same after you reprocess the life event.

When participants do not have to reconsider their original election decisions because of new electable choices or changes to electable choices that they did not choose originally.

Reinstate If Electability Exists for the Backed Out Result

Elections are restored as long as the participant is eligible for the electable choices.

For example, you changed the value of an activity rate that the participant originally chose before reprocessing the life event. When you reprocess the life event, those elections are restored with the new rate as long as the participant is eligible for that electable choice.

Caution

If an activity rate increases, the participants' election automatically increases in cost and there may not be an opportunity for the participant to reevaluate the election.

When you:

  • Want to apply any changes to the participant's original elections without providing an opportunity for participants to review the changes.

  • Do not want participants to review any new electable choices.

Never Reinstate

Elections are not restored.

When you:

  • Do not want to restore participant elections after reprocessing the life event.

  • Want to use a specific life event to make adjustments or corrections to a benefit offering and you want participants to reevaluate their original elections.

Managing Rates for Open Enrollment: Points to Consider

When preparing benefits offerings for open enrollment, create rates for new benefits offerings and update rates for existing offerings as required.

Consider these aspects of creating and updating rates:

  • Creating new rates for new benefits offerings

  • Updating existing standard rates

  • Updating existing variable rates

  • Updating elements for existing rates

  • Updating flex credit offerings

  • Editing rates in the integrated workbooks

  • Configuring rate display for self-service enrollment

Creating Rates for New Benefits Offerings

Ensure that the new rates that you create have the same effective start date as your new benefit offerings. When you create the new rate on the Create Standard Rates page, edit the session effective date to match the effective start date of the corresponding new plan or option.

Updating Existing Standard Rates

Update existing standard rates if there are any changes to rate calculations or other details. Use the Manage Rates task in the Plan Configuration work area, and search for the standard rate as of the first day of your new plan year. Searching by this date sets the session effective date for the rate updates. Select the standard rate and make changes to the calculations using the Update action.

Updating Existing Variable Rates

There are two possible scenarios to consider when you update existing variable rates:

  • You want to edit the calculation details for an existing variable rate profile. In this case, follow these steps:

    1. On the Manage Variable Rate Profiles page, search for the variable rate profile effective as of the start date of the new plan year, typically the first of January. Searching by this date sets the session effective date for the rate updates. Make changes to the variable rate calculations using the Update action.

    2. No updates are required on the corresponding standard rates page, because the revised calculation goes into effect on the effective start date of the revised variable rate profile.

  • You want to attach a different variable rate profile to the standard rate. For example, you now want to use two age band variable rate profiles for the same age range where you formerly used just one profile. In this case, follow these steps:

    1. Search for the standard rate using the effective as of date that is one day before the effective start date of the new variable rate. For example, if the new variable rate is effective on 01 January 2016, search for the corresponding standard rate as of 31 December 2015. Edit the rate using the Update action. The session effective date reflects 31 December 2015. On the Edit Standard Rate page, end-date the unwanted variable rate profile in the Variable Rates section and click Save and Close.

    2. Search again for the standard rate, this time using the effective start date of the new variable rate in the Effective As-Of Date field, which sets the session effective date. In this example, the date is 01 January 2016. Edit the rate using the Update action, adding the new variable rate profiles to the rate.

Updating Elements for Existing Rates

Consider whether any of your rates require a different payroll element. For example, you formerly used a single payroll element for all medical plans, but for the next plan year you require a distinct element for each medical plan. If you must attach a different element to an existing standard rate, search for the rate as of the first day of the new plan year and use the Update action to attach the new element. The association of the current payroll element with the rate is end-dated effective the day before the first day of the new plan year.

Updating Flex Credit Offerings

Update existing flex credit shell plans if there are any changes to flex credit calculation methods, spending options, or excess credit calculations. Use the Manage Flex Credits Configuration task in the Plan Configuration work area and search for the flex credit shell plan as of the first day of your new plan year. Searching by this date sets the session effective date for the flex shell plan updates. Select the flex shell plan and make changes using the Update action.

Editing Rates in Integrated Workbooks

You can use the Microsoft Excel integrated workbook available on the standard rates search page to edit and upload multiple standard rates at once. You can also use the integrated workbook on the variable rate profiles search page to create, edit, and upload multiple variable rate profiles and then associate them with existing standard rates.

Configuring Rate Display for Self-Service Enrollment

You can configure the name and visibility of rate columns on each step in the self-service enrollment guided process. Use the Configure Plan Type Grouping Display task in the Plan Configuration work area.

Restarting Coverage for Flexible Spending Accounts: Points to Consider

Flexible spending accounts (FSA) might have requirements to start new on a certain date. For example, FSA plans in the US, such as health care and dependent care reimbursement, typically must start new every calendar year. FSA plans also typically require explicit entry of the enrollment amount, even if the participant was enrolled in the previous year and plans to continue the same coverage level for the following year. The coverage of a participant who is currently enrolled should end on December 31 and restart on January 1.

This topic discusses the following important setup considerations and testing procedures to ensure that participants explicitly restart coverage for the FSA plan each year.

  • Specifying effective date

  • Selecting the enrollment method

  • Selecting the enrollment rule

  • Selecting the default enrollment rule

  • Checking the setup using a report

  • Testing the setup in a test instance

To configure the FSA plan, select the plan from the program hierarchy on the Edit Program Enrollment page and then select the Open event on the Scheduled tab.

Specifying the Effective Date

When you make updates to the FSA plan, ensure that the session effective date is the first day of the new benefit year, typically January 1.

Selecting the Enrollment Method

Verify that the enrollment method of the FSA plan is Explicit.

Selecting the Enrollment Rule

Select the enrollment rule Current - keep or choose, starts new; new - can choose so that current enrollees must explicitly reelect coverage amounts, even though the coverage amount might stay the same. The coverage ends at the configured end date for the processed life event and restarts the next day.

Selecting the Default Enrollment Rule

Select one of the following default enrollment rules, depending on your plan configuration:


Default Enrollment Rule

Usage Conditions

New - nothing; current - nothing

Typical default enrollment rule to force participants with current year coverage to reeelect coverage for the new plan year.

New - default; current - default

If your FSA plan configuration includes a waive plan or option, select this default enrollment rule on the waive plan or option.

New - default; current - same enrollment but default rate

If the standard rate for the FSA object has a default of zero.

Checking the Setup Using the Participant Enrollment Results Report

To run the Participant Enrollment Results report, search for it in the Reports and Analytics work area.

  1. View the report results as of one day before processing the open event to obtain a list of current enrollees in each FSA plan, and their current elected amount.

  2. Run the same report after the open enrollment period ends to verify that coverage has been reelected, or ended, according to participant elections.

Testing Procedure in a Test Instance

Follow these steps after you set up the enrollment rules in a test instance:

  1. Process the open event as of the first day of your new plan year.

  2. Search for the enrollment information of a participant who is currently enrolled in the FSA plan.

  3. For this date, verify that the Enrollment Results page does not display the existing enrollment in FSA Health Care Coverage plan. However, it does display existing enrollment in other benefit plans, which is expected.

  4. On the Enrollment page, explicitly select the FSA Health Care Coverage plan and specify the coverage amount, to enroll again for the new plan year.

  5. Verify that the coverage start date is the first day of your plan year and the original coverage start date is as expected.

  6. Select the first day of your new plan year as the session effective date.

  7. Verify that the Enrollment Results page shows that coverage ended on the last day of the previous plan year and restarted on the first day of the new plan year.

You can follow the same procedure to test the self-service enrollment for a worker by using this method to open the worker's self-service enrollment pages:

  1. Verify that Parameter Display is selected on the Manage Self-Service Enrollment Configuration page.

  2. On the Navigator, select Benefits in the My Information group.

  3. Select the person.

  4. Click Continue.

Configuring Enrollment Display: Points to Consider

You can configure how plans are grouped and displayed on each step in the self-service guided enrollment process and on each administrator enrollment tab

This topic discusses the following decision points:

  • Grouping plans for enrollment

  • Configuring enrollment display

  • Configuring rate display

Grouping Plans for Enrollment

Group plan types into display categories in the Manage Plan Types task. For each plan type:

  • Specify a category for displaying plans in self-service enrollment steps.

  • Specify a category for displaying plans in administrative enrollment tabs.

You can group plan types together for display by assigning the same display category to multiple plan types. For example, you could group several different life insurance plan types together into a single Life Insurance display category. For a single plan type, you can choose a different category for self-service display compared to the administrative display.

When you create new plans, you assign each to a plan type. Each plan inherits the enrollment display category of its assigned plan type.

Configuring Enrollment Display

Use the Manage Plan Grouping page to configure the visibility and display names of plan type enrollment categories for:

  • Steps in the self-service enrollment guided process

    You can change the names of the plan type category groupings, which correspond to self-service enrollment step names, and you can control whether each step is visible. You can also enter a description of the plan grouping to associate with the selected enrollment display name. Participants see this description during self-service enrollment.

  • Tabs for administrator usage

    You can change the names of the plan type groupings, which correspond to tabs in the Benefits Service Center enrollment tasks. You can also specify whether to display each tab.

You can modify only the name and visibility of plan groupings, but you cannot create new groupings on this page. If you decide not to display a plan grouping for self-service enrollment, the benefits administrator can still enroll a participant in that plan grouping if it is displayed for administrator usage.

Configuring Rate Display

Click the button for the plan in the Rate Column Display column to configure the name and visibility of rate columns on each step in the self-service enrollment guided process.

  • You can specify which columns to display on each plan grouping step in the enrollment process. However, the Primary Rate column cannot be hidden.

    For example, you can display rate column 2 on the medical step, but not on the dental step.

  • You can name the displayed rate columns differently on different enrollment steps.

    For example, you can name the first two rate columns Employee Cost and Employer Cost on the medical enrollment step, and name them Pretax and After-Tax on the insurance enrollment step.

It is important to understand that the taxation is not affected by the column name that you enter.

Identifying and Resolving In-Progress Life Events Before Open Enrollment: Explained

On a given day, you can process only one life event in a single benefits relationship for a participant. The Evaluate Scheduled Event Participation process does not start an open event for a participant who has an existing life event that is not fully processed. Therefore, process and resolve in advance all existing life events that would conflict with the open life event.

To resolve life events that are not closed or fully processed:

  1. Identify incomplete life events.

  2. Resolve incomplete life events.

  3. Identify and finalize open action items.

  4. Evaluate and resolve detected temporal events.

Identify Conflicting and Incomplete Life Events

Incomplete and conflicting life events include events that are:

  • Detected for participants, but not yet processed

  • Started or processed, but not closed

  • Suspended, awaiting fulfillment of action items

  • Detected by temporal processing

To identify participants with incomplete events that require resolution, use one of these reports:

  • On the Life Events tab in the Evaluation and Reporting work area, search by specifying the event status and other report parameters. For example, you can search for all life events in the Detected status and view by legal employer. Click the Details button to see the list of participant names for each employer.

  • View the Totals by Life Event summary report for life events that are not processed. Search for the Participant Enrollment Results report in the Reports and Analytics work area and click More.

Resolve Life Events

To resolve the in-progress life events for each participant, use the Person Life Events task in the Enrollment work area. Follow these steps:

  1. On the Potential Life Events tab, resolve all life events in the Detected or Unprocessed status by taking one of these actions:

    • Delete the life event.

    • Process the life event.

    • Void the life event, if it does not have to be processed, by changing the status to Voided.

  2. On the Life Events tab, resolve the life events that are in the Started status:

    • If the enrollment period has passed, then close the life event by selecting the started event and selecting the Close action, specifying a date.

    • If the enrollment period has not passed, you can process the life event for the participant, allow enrollment if applicable, and then process the Open event separately for these participants.

Note

You can also use the Close Enrollment process in the Election Processes section of the Evaluation and Reporting Work area to close enrollment for a large group of participants. However, even though enrollment is closed for the prior event, any suspensions caused by unfulfilled action items conflict with open event creation.

Identify and Finalize Open Action Items and Suspensions

As long as there is a prior life event with a suspension in place because of an unfulfilled action item, the next life event will not process for that participant. Therefore, you must resolve and close the open and suspended action items for each participant before you process the open event.

To finalize open action items and suspensions:

  1. Run the Close Action Items process in the Evaluation and Reporting work area. View the process report to see a list of participants with pending action items.

  2. Follow up with those participants to complete their action items.

  3. Click Manage Enrollment Activities on the Enrollments page in the Enrollment work area.

  4. Depending on what item the participant is fulfilling, select the election and in the Enrollment Activities section:

    • Enter and save the dependent or beneficiary information.

    • Enter and save the received date for the certification.

  5. On the Action Items tab, confirm that your action or certification shows as completed and the date of completion.

  6. Close the life event.

Evaluate and Resolve Temporal Events

The Evaluate Scheduled Event Participation process can detect life events triggered by temporal events, such as age or salary change, based on selected process parameters. If the event date of a detected temporal event is prior to the open event date, the open event fails to process for that participant.

If your organization uses temporal processing to create detected events, you can minimize such conflicts by running the Evaluate Temporal Event Participation process a few days before open event processing. Resolve as many as possible of the detected temporal events before processing the Open event.

Processing Trial Open Enrollment: Explained

One month before your actual open enrollment, run a trial open enrollment in a test instance to tune performance and validate plan configuration for the upcoming plan year. At this point, in your production instance, you have prepared your programs and plans, updated your standard and variable rates, and configured enrollment and rate display. You also configured flexible spending account plans to start new coverage, closed in-progress life events, finalized and closed action items, and processed and resolved temporal event participation. Now, you create a separate test instance from this production instance with all or a representative sample of your participants and manage your trial open enrollment.

The trial open enrollment mimics many aspects of the actual open enrollment process, as shown with the following basic high-level tasks:


Task

Work Area

Phase I Trial Open Enrollment

Phase II Actual Open Enrollment

Generate the Participant Enrollment Results report.

Reports and Analytics

Identify test participants.

Compare enrollments before and after open enrollment.

Identify any in-progress life events and resolve them before processing open enrollment.

Run the Evaluate Scheduled Event Participation and Enroll in Default Benefits processes.

Evaluation and Reporting

Yes

Yes

Monitor processes and resolve any errors.

Evaluation and Reporting

Enrollment

Yes

Yes

Identify and fix performance issues.

Evaluation and Reporting

Yes

Refine as required.

Iteratively, check plan configuration and rates using sample employees and fix errors as required.

  1. Backout the open life event.

  2. Correct setup.

  3. Rerun the open event.

Evaluation and Reporting

Enrollment

Self-Service

Plan Configuration

Yes

Validate on an exception basis.

Enter enrollments.

Self-Service

Enrollment

On a test basis

Yes

Identify and Fix Performance Issues

It is difficult to determine the amount of time it takes to process a single person due to the variables that can impact performance. These variables include complexity in plan configuration, hardware, network usage, optimized table usage, as well as general database tuning.

Poor performance times are often caused by not running table statistics on a regular basis. In the Evaluation and Reporting work area:

  • Check that the threads parameter is set to the number of CPUs for the computer, at a minimum.

  • Check that the chunk size is appropriate to the quantity of rows being written to the database. Use a smaller value when writing many rows, such as when processing participants and converting annual enrollments.

  • Analyze and adjust your maximum error threshold as required using the Manage Batch Parameters task. For example, if you process your trial open enrollment using your entire participant population, processes might fail because they reached the maximum errors threshold.

  • Analyze all index column statistics and gather column, schema, and table statistics before the following processes.

    • Evaluate Scheduled Event Participation

    • Enroll in Default Benefits

    • Close Enrollment

Managing Open Enrollment Period: Explained

Process your open scheduled event so that participants can make their benefits elections. At this point, you have completed your trial open enrollment where you validated your programs and plans, standard and variable rates, and enrollment and rate display configuration. You have also configured flexible spending plans to start new coverage, closed unprocessed life events, finalized and closed action items, and processed and resolved temporal event participation.

During your trial open enrollment you focused on performance and validation. Now during your actual open enrollment period, you focus on monitoring and managing the open enrollment period, participant enrollments, and intervening life events.


Task

Work Area

Phase ITrial Open Enrollment

Phase IIActual Open Enrollment

Generate the Participant Enrollment Results report.

Reports and Analytics

Identify test participants.

Compare enrollments before and after open enrollment.

Identify any in-progress life events and resolve them before processing open enrollment.

Run the Evaluate Scheduled Event Participation and Enroll in Default Benefits processes.

Evaluation and Reporting

Yes

Yes

Monitor processes and resolve any errors.

Evaluation and Reporting

Enrollment

Yes

Yes

Identify and fix performance issues.

Yes

Refine as required.

Iteratively, check plan configuration and rates using sample employees and fix errors as required.

  1. Backout the open life event.

  2. Correct setup.

  3. Rerun the open event.

Evaluation and Reporting

Plan Configuration

Yes

Validate on an exception basis.

Enter enrollments.

Self-Service

Enrollment

On a test basis

Yes

Process life events that occur during the open enrollment period.

Enrollment

Not applicable

Yes

Manage the open enrollment window.

Evaluation and Reporting

Not applicable

Yes

Close open enrollment.

Evaluation and Reporting

Not applicable

Yes

Scheduled Event Participation Process: Points to Consider

When preparing to submit the Evaluate Scheduled Event Participation process in the Evaluation and Reporting work area, pay particular attention to setting the following key parameters.


Parameter

Comments

Effective Date

Select the first day of your open enrollment period, for example, 1-Nov-2015.

Detect Temporal Events

Regardless of whether you decide to detect all, some, or no temporal life events, the open event evaluates each participant's age, length of service, salary, and other temporal factors during processing.

Person Type

To exclude terminated participants, select Employee or Participant.

Life Event Occurred Date

Select the date as of which eligibility is evaluated and rates are determined. For the open event, this date is typically the first day of the new benefit year, for example, 1-Jan-2016.

Life Event

Select Open.

Apply Defaults

Select Yes to run the Enroll in Default Benefits process automatically after the Evaluate Scheduled Event Participation process completes so that participants can view their default enrollments when they enroll.

Select No to apply default enrollments later using the Enroll in Default Benefits process. For example, you might run the process after participants finish electing their enrollments and before you close the enrollment period.

Audit Log

Select Yes only for troubleshooting. It causes the application to generate detailed audit logs. Processing stops for any process generating an audit log, after that log becomes full.

Select No to generate only summary information if you are processing your entire participant population.

Tip

To limit the population processed, you can set additional parameters, such as Benefits Group, Location, Legal Entity, and others, or write a person selection formula.

Process Default Enrollments

Depending on how you configured your programs and plans, the Enroll in Default Benefits process does the following:

  • Enrolls participants using their current enrollments if they make no explicit election choices

  • Assigns participants new default enrollments

  • Changes current elections to a new default election, for example, you have a dependent care spending plan configuration that sets current participants to nothing or a waive plan or option

Monitor Processes and Resolve Errors: Explained

Always check the process-generated log files to identify and fix any errors in your trial and production instances. You identify and fix many issues during the trial open enrollment, which reduces, but does not eliminate, issues raised during the actual open enrollment. Run the Restart Participation Evaluation and Back Out Life Events processes, as required.

Monitor Processing

Use the Monitor Process Request section of the Overview page to view the percentage of completion for processes and the process-generated logs and reports. For example, the Evaluate Scheduled Event Participation process:

  • Log files identify who failed and how to fix the issue

  • Summary report provides an overall summary of the participants that processed successfully, in error, or were unprocessed as well as the open life events with a Started status

If you cannot run a process that generates an audit log:

  1. Run the Purge Participation Evaluation Audit Data process in the Maintenance Processes section.

    The purge process protects ongoing activities by purging data only from completed batch processes. Purging the audit logs does not affect life event or election information.

  2. Restart the process that was interrupted when the audit log became full.

Warning

You want to generate audit logs only during trial open enrollment. Check that production processes do not generate audit logs, especially for batch processes that use the entire participant population.

Restart Participation Evaluation

Run the Restart Participation Evaluation process after fixing errors, such as errors resulting from reaching the maximum allowable errors or full audit logs.

Back Out Life Events

If the open event must be backed out for the entire participant population or a select group of participants, run the Back Out Life Events process for the Open life event. This is more typically done during the trial open enrollment to retest edited plan configurations.

When backing out open life events, set the resulting life event status to:

  • Unprocessed to include it for future processing

  • Voided to exclude it from any further processing

Processing Life Events That Occur During Open Enrollment Period: Examples

Benefit administrators must act on any intervening life events that might occur during an open enrollment period. For example, a participant might experience a gain dependent life event that can change the electable choices offered during the open enrollment period. In that case, the administrator must allow the life event to back out the open event, take steps to process the intervening life event, and then reprocess the open event.

Any of the following actions can generate intervening life events based on their setup:

  • The Evaluate Temporal Event Participation process detects temporal life event for workers, such as grade or age changes.

  • The administrator or participant adds a contact, for example, a spouse or child, using the Contacts page.

  • The administrator adds a life event manually using the Person Life Events page in the Enrollment work area.

To check if any new intervening life events were detected for participants, you search for events in the Detected status using the Life Event tab on the Summary page in the Evaluation and Reporting work area. To check if any new intervening life events were detected for a specific participant, use the Person Life Events task in the Enrollment work area. Click the Potential Life Events tab to view any detected or unprocessed life events for that worker.

The examples in this topic help administrators to understand various scenarios in which intervening life events can occur, and the steps to resolve the events.

All examples in this topic are based on the following main scenario:

  • The open enrollment period is from November 1, 2015 to November 28, 2015. The new plan year starts January 1, 2016.

  • Coverage and rates for elections made during the open enrollment period start on January 1, 2016.

Resolving an Intervening Life Event That Changes Open Enrollment Electability

A participant gains a spouse on November 20, 2015 and reports the event to the benefits administrator who updates the contact information. The gain dependent life event is detected. The life event provides new electable choices, with rates and coverage effective November 20, 2015. New electable choices are now available for open enrollment as well.

Perform these steps to address this scenario:

  1. In the Enrollment work area for the participant, use the Process Life Event task to evaluate the gain dependent life event. Allow the life event to back out the open enrollment event for that participant. The status of the life event changes to Started.

  2. Ask the participant to make elections based on the gain dependent life event using the self-service enrollment process accessed from My Information in the Navigator, or make elections on the participant's behalf using the Enrollments task in the Enrollment work area.

  3. In the Enrollment work area for the participant, use the Life Events tab in the Person Life Events task to close the gain dependent life event. The status of the life event changes to Processed.

  4. Use the Process Open Enrollment task to reprocess the open enrollment for that participant. Ask the participant to make elections.

Resolving an Intervening Life Event That Does Not Change Electability

A participant reaches 35 years of age on November 1, 2015. You run the Evaluate Temporal Event Participation process on November 5, 2015. The process detects an age-changed life event for the participant and backs out the open event. However, when you processed the open event on November 1, 2015, you already configured the process to detect temporal events, which includes the age-changed event. So, at this time, the age changed event requires no action.

To address this scenario, use the Person Life Events task in the Enrollment work area for the participant to void the life event. To void the life event, on the Life Events tab, select the Back out event action from the Actions menu, and select Voided from the Potential Life Event Status list.

Resolving an Intervening Life Event That Was Added Manually

A participant gains a child on November 20, 2015. The participant reports the event to the benefits administrator who adds a gain dependent life event manually using the Person Life Events task in the Enrollment work area. The benefits administrator sets the life event status to Manual.

Perform these steps to address this scenario:

  1. In the Enrollment work area for the participant, use the Potential Life Events tab in the Person Life Events task to change the status of the gain dependant life event to Unprocessed.

  2. Use the Process Life Event task to evaluate the gain dependent life event. Allow the gain dependent life event to back out the open enrollment event for that participant. The status of the gain dependent life event changes to Started and provides new electable choices, with rates and coverage effective on the date of childbirth.

  3. Ask the participant to make elections based on the gain dependent life event using the self-service enrollment process accessed from My Information in the Navigator, or make elections on the participant's behalf using the Enrollments task in the Enrollment work area.

  4. In the Enrollment work area for the participant, use the Life Events tab in the Person Life Events task to close the gain dependent life event. The status of the life event changes to Processed.

  5. Use the Process Open Enrollment task to reprocess the open enrollment for that participant. Ask the participant to make elections.

Enter Enrollments: Explained

Multiple methods exist for entering enrollments and the open enrollment process typically uses all of them.

  • Participants make their elections using the self-service enrollment guided process. If participants have election opportunities, they can select Benefits under My Information on the navigator menu.

    During the trial open enrollment, you make elections as participants in your sample population by selecting Benefits under My Information on the navigator menu. In your trial environment, Parameter Display must be selected on the Manage Self-Service Enrollment Configuration page for you to make elections as a participant.

  • Benefits administrators enter enrollments for specific participants in the Enrollments work area.

    Benefits professionals can generate a Benefit Enrollment document on the Manage Person Life Events page and send it to participants. Participants can use the document to make their election choices and return the completed document. Benefits professionals use the completed document to enter the participant elections into the Enrollments page in the Enrollment work area.

  • Benefits administrators can run the Enroll in Default Benefits process in the Evaluation and Reporting work area to make default enrollments for participants who did not elect any benefits.

    The Enroll in Default Benefits process might have already run automatically depending on whether you elected to apply defaults as part of the Evaluate Scheduled Event Participation process.

Setting Up and Processing an Open Enrollment Period: Worked Example

This example contains steps to illustrate a basic setup and scenario of how to define an open enrollment period and run the process to evaluate scheduled event participation.

The following table summarizes key decisions in this scenario.


Decisions to Consider

In This Example

Are there any new offerings that you want to add for the open enrollment period?

Yes, add the InFusion Vision plan to the InFusion Wellness program.

What are the start and end dates for the open enrollment period?

Starts November 1, 2015. Ends November 15, 2015.

Which workers in your enterprise do you want to process the open event for?

All workers of the Facilities department.

When do you want eligibility to be evaluated and new rates determined based on elections?

Start date of the new plan year, which is January 1, 2016 in this example.

When do you want the new coverage to start?

Start date of the event

When do you want the previous coverage to end?

One day before the event

When do you want the new rates to become effective?

Start date of the event

When do you want previous rates to end?

One day before the event

Task Summary

Add the new plan to the program. Define the open enrollment period for the program. Process the open event as of the first day of the open enrollment period. Check the enrollment page of a sample worker to verify that all electable choices appear as expected.

Prerequisites

  1. In the Plan Configuration work area, ensure that you've created a plan type called InFusion Wellness. You use the Manage Plan Types task to create the plan type.
  2. In the Plan Configuration work area, ensure that you have created a benefit program called InFusion Wellness with the following configuration:

    Field

    Value

    Program Type

    Core

    Year Periods

    Year periods for the current plan year and the new plan year:

    • January 1, 2015 to December 31, 2015

    • January 1, 2016 to December 31, 2016


  3. In the Plan Configuration work area, ensure that you have created a plan called InFusion Vision with the following configuration:

    Field

    Value

    Plan Type

    InFusion Wellness

    Usage

    In program

    Year Periods

    Year periods for the current plan year and the new plan year:

    • January 1, 2015 to December 31, 2015

    • January 1, 2016 to December 31, 2016


Adding the Plan to the Program

  1. In the Plan Configuration work area, click the Manage Benefit Program Details task to open the Programs tab, and search for the InFusion Wellness program.
  2. In the Search Results table, click the program to open the Edit Program page.
  3. On the Edit Program Basic Details page, set the session effective date to the first day of the current plan year, January 1, 2015.
  4. In the Plans and Plan Types section, click Select and Add Plan.
  5. In the Select and Add: Plan dialog box, complete the fields as shown in this table.

    Field

    Value

    Sequence

    Enter a unique sequence based on the sequence of existing plans in your program.

    Plan

    InFusion Vision

    Status

    Pending


  6. Click OK.
  7. Click Save.
  8. Review the effective start date of the plan that you added. The date should be the first day of the current plan year, January 1, 2015.
  9. Set the session effective date to the first day of the new plan year, January 1, 2016.
  10. Click Save.
  11. In the Plans and Plan Types section, select the InFusion Vision plan.
  12. Click the Update action from the Edit menu.
  13. In the Update Plan in Program dialog box, update the status of the plan to Active.
  14. Click OK.
  15. Click Save.
  16. Review the status and effective date of the InFusion Vision plan. The status should be Active and the effective date should be the first day of the new plan year, January 1, 2016.
  17. Click Save and Close.

Defining the Open Enrollment Period

  1. On the Edit Program page, click the Enrollment step to open the Edit Program Enrollment page.
  2. Select the InFusion Wellness program in the hierarchy, then select the Scheduled tab.
  3. Select Open from the list, which by default is set to create an administrative event.
  4. Click Create in the Periods section.
  5. In the Create Enrollment Period dialog box, complete the fields as shown in this table.

    Field

    Value

    Enrollment Period Start Date

    November 1, 2015

    Enrollment Period End Date

    November 15, 2015

    Close Enrollment Period Date Rule

    When enrollment period ends

    Assigned Life Event Date

    January 1, 2016

    Year Period

    January 1, 2016 to December 31, 2016

    Coverage Start Date

    Event

    Previous Coverage End Date

    One day before the event

    Rate Start Date

    Event

    Previous Rate End Date

    One day before the event


  6. Click OK.
  7. Click Save and Close.

Processing the Open Event

  1. In the Evaluation and Reporting work area, click the Processes tab on the Overview page.
  2. Click the Submit icon button of the Evaluate Scheduled Event Participation row in the Evaluation Summary Process Life Events table.
  3. In the Parameters section, complete the fields as shown in this table. Use the default values except where indicated.

    Field

    Value

    Effective Date

    November 1, 2015, which is the first day of the open enrollment period in this example.

    Life Event Occurred Date

    January 1, 2016, which is the first day of the new plan year in this example.

    Life Event

    Open

    Organization

    Facilities


  4. Click Submit.
  5. In the Monitor Process Request section, search for the process that you submitted and verify that it completed successfully.
  6. Click the View Report icon button of the process that you submitted.
  7. On the process details page, check the Results section to see how many worker records were processed successfully and how many were processed with errors. Click the number to view details about the specific worker records that were processed.
  8. In the Enrollment work area of any worker who belongs to the Facilities department, use the Enrollments task to verify that the new InFusion Vision plan appears as an electable choice.

Manage the Open Enrollment Window: Explained

The day after your open enrollment period ends, run the Close Enrollment process in the Evaluation and Reporting work area. After you run this process, no one can further modify a participant's elections.

Tip

If you have not already done so, run the Enroll in Default Benefits process before closing enrollment.

To close enrollment:

  1. Optionally, run the Close Enrollment process with the Validate parameter set to in Roll back - database will not be updated and optionally set the Audit Log parameter to Yes.

    Analyze the generated logs and reports. Investigate and fix any errors.

  2. Run the Close Enrollment process with the Validate parameter set to Save - database will be updated and set the Audit Log parameter to No.

You can extend an open enrollment period when unexpected delays require additional days for certain participant population segments, or the entire population, to complete their annual enrollment selections. Use the Adjust Open Enrollment Window process in the Evaluation and Reporting work area to:

  • Update the enrollment period end date, processing end date, and default enrollment date

  • Provide an appropriate number of extension days

The generated log file displays the details of the new enrollment period for all participants.

If you ran the Close Enrollment process and you now want to reopen the event, you can run the Reopen Life Event process, selecting the event and the population parameters.

Tip

Use the Reopen Life Event process, selecting the Open event, with the Adjust Open Enrollment Window process to extend the annual enrollment window after reopening a closed Open scheduled event.

Tasks after Open Enrollment Period Ends: Explained

Now that your open enrollment period is closed, you are ready to perform the following tasks in the trial or production instance:

  • Verify enrollment.

  • Investigate incorrect enrollments.

  • Close action items and certifications.

  • Enter overrides.

  • Inactivate plans that are no longer offered.

  • Process intervening life events that occur after the open enrollment period.

Verify Enrollment

Generate the Participant Enrollment Results report in the Reports and Analytics work area and compare it with the same report that you generated before you opened enrollment. Use the pre- and post-enrollment reports as well as the reports on the Life Events tab of the Evaluation and Reporting work area to verify that:

  • Participants are no longer enrolled in plans that are not offered in the new plan year

  • Eligibility evaluated correctly

  • Rates and premiums changes are reflected for the new plan year

  • Default plan and option enrollments processed correctly

  • Coverage restarted for flexible spending plans

  • Enrollment included any other plan configuration changes

  • Element entry values are correct for benefit elements

Also verify interim assignments and suspensions, action items and certifications, payroll results, and third-party interfaces.

Investigate Incorrect Elections

For any elections that failed during open enrollment, analyze the issue to determine if the failure occurred for one participant, many, or all. Also, review the setup of the benefit objects involved to determine if there was an oversight in making plan configuration changes or there were incorrect data on an employee.

Close Action Items and Certifications

To indicate that participants have fulfilled outstanding action items and certifications, click Manage Enrollment Activities on the Enrollments page in the Enrollment work area. Depending on what item the participant is fulfilling, select the election and in the Enrollment Activities section:

  • Enter and save the dependent or beneficiary information

  • Enter and save the received date for the certification.

On the Action Items tab, confirm that your action or certification shows as completed and the date of completion.

To close unresolved action items and certifications, run the Close Action Items process in the Evaluation and Reporting work area.

Restriction

The application will not process the next life event until all unresolved action items for the prior life event are resolved, even if the prior life event has a Closed status.

Enter Overrides

Scenarios where overrides might be required are:

  • A few employees live outside of a service area, but work inside the service area and your provider allows for this eligibility override.

  • Special approval has been given to continue coverage for dependents who exceed the plan age limits.

  • A special rate has been agreed to with an employee for a certain length of time.

  • Certain retirees have grandfathered rates that you do not want to change during the annual open enrollment.

In the Enrollment work area, use the:

  • Eligibility Overrides task to maintain override information for a potential participant who is otherwise ineligible for a particular program or plan, such as the service area and continued coverage scenarios.

  • Enrollment Override task to override election information, such as the special and grandfathered rates scenarios. You might have to override eligibility first, to specify that a participant can enroll in a plan or option for which the participant was originally ineligible.

Inactivate Plans That Are No Longer Offered

After all participants are disenrolled from the plans and options that are no longer offered, verify in the Plan Configuration work area that these plans and options will inactivate at the start of the new plan year. For any plans and options that are not already scheduled to inactivate, set the session effective date to the first day of the new plan year and change the status to Inactive.

Process Intervening Life Events That Occur After the Open Enrollment Period

You must act on any intervening life events that might occur after an open enrollment period, but before the start date of the new plan year. For example, a participant might experience an address change life event after the open enrollment period. As a result, the participant might no longer be eligible for the elections made, or might be eligible for other offerings, during the open enrollment period. In that case, the administrator must:

  1. Process the intervening life event and allow it to back out the open event.

  2. Ask the participant to make necessary elections if required.

  3. Reprocess the open event as of any date within the open enrollment period if the intervening life event impacts the eligibility of the open enrollment elections.

  4. Work with the participant to make or update elections using the Enrollment work area.